Erythema multiforme - 多形紅斑
Erythema multiforme minor ― 請注意，病變中心可能會變白。
蕁麻疹也可被視為鑑別診斷。
relevance score : -100.0%
ReferencesErythema multiforme (EM) 是一種因免疫反應而在皮膚和黏膜上出現特徵性靶狀斑點的疾病。雖然大多由病毒感染（尤其是單純皰疹病毒 (HSV)）或特定藥物誘發，但在許多病例中仍找不到明確原因。治療急性 EM 的重點是使用含類固醇或抗組織胺的外用乳膏以緩解症狀。針對每位患者量身訂製的復發性 EM 治療方案最為有效。首選的治療包括口服與局部用藥，常用的有皮質類固醇和抗病毒藥物。局部治療可使用強效類固醇乳膏或針對受累黏膜的溶液。對於對抗病毒藥物無效的患者，第二線選擇包括免疫抑制藥物、抗生素、驅蟲藥及抗瘧藥。
Erythema multiforme (EM) is an immune-mediated condition that classically presents with discrete targetoid lesions and can involve both mucosal and cutaneous sites. While EM is typically preceded by viral infections, most notably herpes simplex virus (HSV), and certain medications, a large portion of cases are due to an unidentifiable cause. Treatment for acute EM is focused on relieving symptoms with topical steroids or antihistamines. Treatment for recurrent EM is most successful when tailored to individual patients. First line treatment for recurrent EM includes both systemic and topical therapies. Systemic therapies include corticosteroid therapy and antiviral prophylaxis. Topical therapies include high-potency corticosteroids, and antiseptic or anesthetic solutions for mucosal involvement. Second-line therapies for patients who do not respond to antiviral medications include immunosuppressive agents, antibiotics, anthelmintics, and antimalarials
Erythema multiforme (EM) is an immune-mediated condition that classically presents with discrete targetoid lesions and can involve both mucosal and cutaneous sites. While EM is typically preceded by viral infections, most notably herpes simplex virus (HSV), and certain medications, a large portion of cases are due to an unidentifiable cause. Treatment for acute EM is focused on relieving symptoms with topical steroids or antihistamines. Treatment for recurrent EM is most successful when tailored to individual patients. First line treatment for recurrent EM includes both systemic and topical therapies. Systemic therapies include corticosteroid therapy and antiviral prophylaxis. Topical therapies include high-potency corticosteroids, and antiseptic or anesthetic solutions for mucosal involvement. Second-line therapies for patients who do not respond to antiviral medications include immunosuppressive agents, antibiotics, anthelmintics, and antimalarials
在許多情況下，輕度 erythema multiforme 會在 2 至 4 週內自行消失。史蒂文斯-約翰遜症候群是一種影響黏膜的嚴重疾病，病程可持續長達 6 週。對於輕度病例，通常不建議使用類固醇。至於是否應在嚴重的多形紅斑中使用類固醇，仍未確定，因為隨機對照研究尚未明確顯示哪些兒童能從此治療受益。
In most cases, mild erythema multiforme is self-limited and resolves in 2 to 4 weeks. Stevens-Johnson syndrome is a serious disease that involves the mucous membranes and lasts up to 6 weeks. There is no indication for using steroids for the mild form. Use of steroids for erythema multiforme major is debatable because no randomized studies clearly indicate which children will benefit from this treatment.
In most cases, mild erythema multiforme is self-limited and resolves in 2 to 4 weeks. Stevens-Johnson syndrome is a serious disease that involves the mucous membranes and lasts up to 6 weeks. There is no indication for using steroids for the mild form. Use of steroids for erythema multiforme major is debatable because no randomized studies clearly indicate which children will benefit from this treatment.
我們報告一例因 TMP/SMX 引發的口腔型 erythema multiforme (EM)，其特徵為典型的口腔及唇部潰瘍，未見皮膚病變。此例強調了與其他口腔潰瘍性疾病鑑別的重要性。患者接受對症治療及口服潑尼松龍片，停用 TMP/SMX 後病情逐漸好轉。
We report a case of oral erythema multiforme (EM) secondary to TMP/SMX that presented with oral and lip ulcerations typical of EM without any skin lesions and highlights the importance of distinguishing them from other ulcerative disorders involving oral cavity. The patient was treated symptomatically and given tablet prednisolone. The condition improved with stoppage of TMP/SMX therapy.
We report a case of oral erythema multiforme (EM) secondary to TMP/SMX that presented with oral and lip ulcerations typical of EM without any skin lesions and highlights the importance of distinguishing them from other ulcerative disorders involving oral cavity. The patient was treated symptomatically and given tablet prednisolone. The condition improved with stoppage of TMP/SMX therapy.
Erythema multiforme 是一種涉及皮膚、偶爾波及黏膜的免疫反應。它通常呈現為靶樣病變，可能為單發、復發或持續存在。這些病變多對稱分布於四肢，尤其是外側表面。主要誘因包括單純皰疹病毒、肺炎黴漿菌等感染，以及某些藥物、免疫接種和自體免疫疾病。 Erythema multiforme 與蕁麻疹的區別在於病灶的持續時間；Erythema multiforme 病灶至少持續 7 天，而蕁麻疹的病變通常在一天內消退。雖然兩者外觀相似，但必須將 Erythema multiforme 與更嚴重的史蒂文斯-約翰遜症候群（Stevens‑Johnson syndrome）區分開來，後者常表現為廣泛的紅斑或紫斑，伴隨水皰。 Erythema multiforme 的治療包括使用局部類固醇或抗組織胺緩解症狀，同時找出並處理根本原因。對於與單純皰疹病毒相關的復發病例，建議採取預防性抗病毒治療。若黏膜受累嚴重，可能需要住院接受靜脈輸液與電解質補充。
Erythema multiforme is a reaction involving the skin and sometimes the mucosa, triggered by the immune system. Typically, it manifests as target-like lesions, which may appear isolated, recur, or persist. These lesions usually symmetrically affect the extremities, particularly their outer surfaces. The main causes include infections like herpes simplex virus and Mycoplasma pneumoniae, as well as certain medications, immunizations, and autoimmune diseases. Distinguishing erythema multiforme from urticaria relies on the duration of lesions; erythema multiforme lesions remain fixed for at least seven days, while urticarial lesions often vanish within a day. Although similar, it's crucial to differentiate erythema multiforme from the more severe Stevens-Johnson syndrome, which typically presents widespread erythematous or purpuric macules with blisters. Managing erythema multiforme involves symptomatic relief with topical steroids or antihistamines and addressing the underlying cause. For recurrent cases associated with herpes simplex virus, prophylactic antiviral therapy is recommended. Severe mucosal involvement may necessitate hospitalization for intravenous fluids and electrolyte replacement.
Erythema multiforme is a reaction involving the skin and sometimes the mucosa, triggered by the immune system. Typically, it manifests as target-like lesions, which may appear isolated, recur, or persist. These lesions usually symmetrically affect the extremities, particularly their outer surfaces. The main causes include infections like herpes simplex virus and Mycoplasma pneumoniae, as well as certain medications, immunizations, and autoimmune diseases. Distinguishing erythema multiforme from urticaria relies on the duration of lesions; erythema multiforme lesions remain fixed for at least seven days, while urticarial lesions often vanish within a day. Although similar, it's crucial to differentiate erythema multiforme from the more severe Stevens-Johnson syndrome, which typically presents widespread erythematous or purpuric macules with blisters. Managing erythema multiforme involves symptomatic relief with topical steroids or antihistamines and addressing the underlying cause. For recurrent cases associated with herpes simplex virus, prophylactic antiviral therapy is recommended. Severe mucosal involvement may necessitate hospitalization for intravenous fluids and electrolyte replacement.
病情範圍從輕微的自限性皮疹到嚴重、危及生命的多形性紅斑（亦可累及黏膜），不等。黏膜受累或出現大皰是判斷嚴重程度的重要指標。
- Erythema multiforme minor：典型的目標樣或分佈於肢端的凸起、水腫性丘疹。此輕度型常伴輕度搔癢（但有時搔癢亦可相當劇烈）、粉紅色斑點，呈對稱排列，起始於四肢。皮疹通常於 7–10 天內自行消退。
- Erythema multiforme major：典型的目標樣或凸起、水腫性丘疹，分佈於肢端，且累及一層或多層黏膜。表皮脫落面積不超全身表面積的 10%。
○ 治療 - 非處方藥
若伴有發燒（體溫升高），應儘速就醫。疑似致病藥物需停用（如抗生素、非類固醇抗發炎藥）。可口服抗組織胺藥，如 cetirizine(西替利嗪) 或 loratadine(氯雷他定) 以緩解搔癢。
#Cetirizine [Zytec]
#LevoCetirizine [Xyzal]
#Loratadine [Claritin]